34 Hyperbaric Oxygenation Therapy KCE Reports 74 Figure 19. Acute presentation of ISSHL: Mean hearing improvement over all frequencies (dB) Source: Bennett et al. 21 Figure 20. Chronic presentation of ISSHL: some improvement, all grades as measured by audiometry Source: Bennett et al. 21
KCE Reports 74 Hyperbaric Oxygenation Therapy 35 The HAS, 37 <strong>the</strong> IECS, 38 and <strong>the</strong> AHRQ assessments come to similar conclusions. 14 Within <strong>the</strong> COST B14 program (see before), a European RCT for HBOT in <strong>the</strong> acute treatment of sudden idiopathic sensorineural hearing loss (study co-ordinator: A. Bar<strong>the</strong>lemy, Marseille, France) is <strong>report</strong>ed to have started in September 2002 with seven centres participating and 56 patients have been included (information from 2005). 42 However, no results have been found. 3.4.12 Acute ophthalmological ischemia 3.4.12.1 Short description of <strong>the</strong> condition Central retinal artery occlusion can result in a sudden interruption of <strong>the</strong> blood supply to <strong>the</strong> retina, causing unilateral loss of vision. This is a rare disease usually occurring between ages 50 to 80, with sudden, painless, a unilateral visual field defects, sometimes preceded by transient episodes of vision loss (amaurosis fugax). 61 This disease is most often cased by embolism of <strong>the</strong> retinal artery. Visual prognosis is poor and attempted treatment is based on medical treatment trying to improve perfusion of <strong>the</strong> retina. 3.4.12.2 Summary of <strong>the</strong> evidence The ECHM considers HBOT optional in acute ophtalmological ischemia (type 3, level C recommendation). 9 The indication is not mentioned in <strong>the</strong> UHMS guidelines. 8 The HAS <strong>report</strong> takes over <strong>the</strong> ECHM recommendation, 37 while <strong>the</strong> IECS <strong>report</strong> refers to an uncontrolled pilot trial with 21 patients in Germany from Weinberger et al., but without solid conclusions. 38, 62 A STEER <strong>report</strong> from 2002 found only two retrospective comparisons of case series, one with 16 patients (eight with HBOT but without randomisation) and a second with 35 patients treated with HBOT compared to 37 patients treated in a centre where no HBOT was available. The <strong>report</strong> concludes that no reliable evidence about <strong>the</strong> benefits of HOBT could be found in people with acute retinal ischemia. Again, it is concluded that RCTs are feasible and should be carried out. 3.4.13 Neuroblastoma stage IV 3.4.13.1 Short description of <strong>the</strong> condition Neuroblastoma is a cancer that arises in immature nerve cells and affects mostly infants and children. Stage 4 is a primary tumour with dissemination to distant lymph nodes, bone, bone marrow, liver, skin, and/or o<strong>the</strong>r organs. 63 3.4.13.2 Summary of <strong>the</strong> evidence According to <strong>the</strong> ECHM, adjuvant HBOT for this indication should be considered although no RCTs are available to support this. 9 The UHMS does not mention this indication. 8 The HAS <strong>report</strong> mainly follows <strong>the</strong> ECHM recommendation, 37 while nei<strong>the</strong>r <strong>the</strong> AHRQ 14, 38 nor <strong>the</strong> IECS <strong>report</strong> do not mention this indication. 3.4.14 Pneumatosis Cystoides Intestinalis 3.4.14.1 Short description of <strong>the</strong> condition Pneumatosis Cystoides Intestinalis (PCI) is a rare disease and describes <strong>the</strong> presence of gas-containing cysts in <strong>the</strong> bowel wall. It is a radiographic finding and not a diagnosis, as <strong>the</strong> aetiology varies from benign conditions to fulminant gastrointestinal disease. 64 3.4.14.2 Summary of <strong>the</strong> evidence For <strong>the</strong> ECHM, HBOT may be used in selected cases of pneumatosis cystoides intestinalis as an alternative to surgery, when <strong>the</strong>re is no sign of acute complications such as perforation, peritonitis and bowel necrosis (type 3, level C recommendation). 9 The UHMS does not mention this indication in its guidelines. The HAS <strong>report</strong> mainly confirms <strong>the</strong> indication from ECHM, without additional evidence. 37